三个地区结核病定点医疗机构结核分枝杆菌感染控制现状调查分析

Survey on current situation of tuberculosis {TB） infection control in designed medical institutions of tuberculosis in 3 cities

目的了解我国结核病定点医疗机构（简称“定点医疗机构”）结核分枝杆菌感染控制工作现状，为加强我国的结核分枝杆菌感染控制工作、降低医院内结核分枝杆菌的传播提供建议。方法2013年3月至5月对我国3个地级市的12家结核病定点医疗机构开展结核分枝杆菌感染控制状况现场调查和测量。采用描述性分析方法分析结核分枝杆菌感染控制中组织管理与管理措施、环境工程控制和个人防护等3个方面的情况。对门诊、实验室和病房的每小时换气次数（AcH）和紫外线辐照强度进行测量。其中ACH≥12次／h为通风良好；紫外线杀菌灯辐照强度≥70μW／cm2为合格。结果在调查的12家结核病定点医疗机构中，建立结核分枝杆菌感染控制规章制度者有8家；门诊布局合理者只有2家，通风良好者有10家，紫外线杀菌灯辐照强度合格者有6家；实验室布局合理者只有6家，通风良好者有6家，紫外线杀菌灯辐照强度合格者有5家；病房布局合理者有3家，通风良好者有11家。4家机构的病房安装紫外线杀菌灯，只有1家机构的紫外线杀菌灯辐照强度达到合格要求。11家机构能够为医务人员提供医用防护口罩，10家机构能够为结核病患者和疑似结核病就诊者提供医用外科口罩。结论3个地区定点医疗机构结核分枝杆菌感染控制工作整体薄弱，需要全面加强，特别是加强实验室结核分枝杆菌感染控制工作。

Objective To strengthen TB infection control and provide some suggestions for reducing the transmission of Mycobacterium tuberculosis by understanding the current situation of TB infection control in designa- ted medical institutions in China. Methods Field survey on current situation of TB infection control was conducted in 12 designed medical institutions of TB in 3 cites from March to May in 2013. Descriptive analysis was used to analyze the administrative control, environmental control and personal protective equipment. Air change per hour （ACH） and intensity of ultraviolet irradiation were measured in outpatient departments, laboratories and inpatient wards separately. Good ventilation is defined by ACH≥12/h. The requirement of the intensity of ultraviolet irradia- tion is over 70μW/cm2. Results Of the 12 TB prevention and control institutions, 8 institutions had the regula- tions of TB infection control. The outpatient departments of 2 institutions were properly designed, of 10 institutions where ACH reached the requirement, and of 6 institutions where the intensity of ultraviolet irradiation reached the requirement. The laboratories of 6 institutions were properly designed, of 6 institutions where ACH reached the re- quirement, and of 5 institutions where the intensity of ultraviolet irradiation reached the requirement. The inpatient departments of 3 institutions were properly designed, of 11 institutions where ACH reached the requirement. Ultra- violet lights were installed in the wards of 4 institutions and the intensity of ultraviolet irradiation that reached the requirement only in 1 institution. Eleven designed medical institutions could supply the protective face masks formedical use for health care workers and 10 institutions could supply medical surgical masks for TB patients and TB suspects. Conclusion The TB infection control work is weak and should be strengthened comprehensively in de- signed medical institutions of TB, especially in the laboratory.